This is an application for a K23 award for Dr. Vanessa Grubbs, a nephrologist at the University of California, San Francisco, who seeks to establish herself as a young investigator in patient-oriented clinical research on the periodontal-chronic kidney disease relation. This K23 award will provide Dr. Grubbs with the support necessary to accomplish the following goals: (1) to become expert at patient-oriented clinical research in the study of the periodontal-chronic kidney disease relation; (2) to conduct clinical investigations of the effect of periodontal disease on chronic kidney disease (CKD) progression; (3) to implement advanced biostatistical methods in clinical studies; (4) to develop and implement a pilot intervention study; and (5) to develop an independent clinical research career. To achieve these goals, Dr. Grubbs has assembled a mentoring team comprised of two co-primary mentors: Dr. Kirsten Bibbins-Domingo, an internist and epidemiologist funded by the NIH, with expertise in population research in CKD and cardiovascular disease among vulnerable populations and Dr. Neil Powe, the Constance B. Wofsy Distinguished Professor of Medicine and NIH-funded researcher in kidney disease. Her multidisciplinary mentoring team also includes Drs. David Lovett, a nephrologist whose research focuses on proinflammatory pathways of renal fibrosis and progression,; Steven Offenbacher, a periodontologist whose research focuses on the systemic effect of periodontal pathogens; and Peter Ganz, a cardiologist and renowned expert in endothelial function. Chronic kidney disease remains a prevalent public health issue despite intense efforts targeting traditional risk factors. Dr. Grubb' research will focus on defining the independent effect of a novel risk factor, periodontal disease, on kidney function decline and factors that may predispose greater risk in both the general population (Aim 1) and among a population at high risk for CKD progression (Aim 2) and to pilot an intervention of intensive periodontal disease treatment among an underserved population with CKD (Aim 3). For Aims 1 and 2 Dr. Grubbs will capitalize on existing cohort data from the National Health and Nutrition Examination Survey and the Jackson Heart Study linked to create longitudinal data and utilize advanced multivariate statistical analyses. The pilot study in Aim 3 will provide the basis for a large, multi-site intervention trial to determine to what extent treatment of periodontal disease can slow progression of clinically evident kidney disease, to be proposed in an R01 grant application towards the end of the K award.